Provider Demographics
NPI:1184719890
Name:NUETZEL, FREDERICK G (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:G
Last Name:NUETZEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W OHIO ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1533
Mailing Address - Country:US
Mailing Address - Phone:765-569-3296
Mailing Address - Fax:765-569-5069
Practice Address - Street 1:825 W OHIO ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1533
Practice Address - Country:US
Practice Address - Phone:765-569-3296
Practice Address - Fax:765-569-5069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice